Cancer has visited my family multiple times but none of the patients were in their old age. We have lost two people to cancer as of today and right now someone in my family is going through chemotherapy in his 50’s. The highlight here is none of them were elderly and so you might be guessing as to why am I even writing about a checkup that mainly matters for older cancer patients? The reason is, the more I read, the clearer it became that this is something that many of us will face eventually. As life expectancy goes up, more people will live long enough to develop cancer in old age and that simply because the risk of cancer itself keeps rising with age. So down the line, many of us will end up sitting beside an elderly parent or relative in an oncologist’s room or even if our first brush with cancer in the family was with someone younger. As well as we don’t like to think, it could be one of us if we live long enough.
I work in clinical data science and as part of my job do work on oncology trials, so people assume I already know everything about cancer care but this one thing I learned only recently. It is called a Geriatric Assessment, or GA and a simpler bedside version doctors use is called a Practical Geriatric Assessment, or PGA.
A GA is a simple checkup that looks at the whole person and not just the tumour. Simply put, two people who are both 70 years old can be very different. One may be active and fit while another may struggle to climb stairs or may be forgetful. A GA tries to capture these differences before treatment starts.
This is not something complicated. There is usually a short form that takes about few minutes to fill followed by few simple tests, like a short walk, a basic memory check, a review of all the medicines the person is taking, to name a few. Usually no machines or special equipment are needed for this and it only needs someone willing to ask and observe properly.
If you are the patient or the caregiver, here is what this kind of visit can look like. You may be given a short form to complete before the doctor even sees you. The patient may be asked to walk a little or stand up from the chair a few times. You may also be asked about falls, memory, mood and who is the helper (for the patient) at home. These questions feel unrelated to cancer but they are not and help to decide how treatment is planned.
As a caregiver, your observations matter a lot here. Elderly patients in our families often hide small problems where they will say “I am fine, it is just old age” even when something is actually wrong. So know your patient and when the doctor asks, answer honestly, even if the patient brushes it off.
This is something I did not know before that a Geriatric Assessment is strongly recommended by cancer groups like ASCO but it is not compulsory and it is not done everywhere. In many places particularly in growing economies, an oncologist may be seeing many patients in one sitting and this can easily get skipped not because anyone is careless but because there is simply no time. Under such circumstances, being aware helps and you may have to ask for it yourself. You do not need to know any medical language for this. You can simply say, “Doctor, since my “so and so” is elderly, is there some kind of fitness check or geriatric assessment you would suggest before starting chemo.” Most doctors will understand this immediately.
Also know that even big hospitals with full geriatric teams are rare. ASCO recently made guidelines for places with fewer resources too because most of the world, does not have a complete team of geriatric specialists for every cancer patient. Even a basic version of this checkup is considered useful and worth asking for.
From what I have understood, when a GA finds a problem early, like poor nutrition or risk of falling and the treatment plan is adjusted for it, elderly patients usually handle chemotherapy better. There are fewer emergency hospital visits and fewer surprises for the family.
My own experience with cancer in the family happened relatively in the middle age, so falls and memory loss were never part of our story. But I know that is exactly what becomes part of the story when cancer happens in old age and that is the gap I want to help close for other families.
If you are about to start this journey with an elderly relative, carry a list of all their medicines, be honest about falls, memory and mood, and simply ask if a geriatric assessment has been done. It is one small question that can change how the next few months could go.
This is based on my own reading and not any sort of medical advice. Please talk to your own doctor/oncologist for decisions specific to your situation.
Based on ASCO’s 2018, 2023, and 2025 geriatric oncology guidelines and patient education material from the American Cancer Society.